| The Grounded Mind Therapy And Consultation, L.l.c. | |
|
1817 Green Cir Valdosta GA 31602-2885 | |
| (229) 244-9688 | |
| Not Available |
| Full Name | The Grounded Mind Therapy And Consultation, L.l.c. |
|---|---|
| Speciality | Social Worker |
| Location | 1817 Green Cir, Valdosta, Georgia |
| Authorized Official Name and Position | Chastidy Boutin (OWNER/OPERATOR) |
| Authorized Official Contact | 7063412745 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Grounded Mind Therapy And Consultation, L.l.c. 1817 Green Cir Valdosta GA 31602-2885 Ph: () - | The Grounded Mind Therapy And Consultation, L.l.c. 1817 Green Cir Valdosta GA 31602-2885 Ph: (229) 244-9688 |
| NPI Number | 1548079700 |
|---|---|
| Provider Enumeration Date | 01/02/2025 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/07/2025 |
| Medicare PECOS PAC ID | 1052841830 |
|---|---|
| Medicare Enrollment ID | O20250208000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548079700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Chastidy Mareya Boutin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447916333 PECOS PAC ID: 2961932744 Enrollment ID: I20250208000071 |
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